Practice Performance Consultant RN - Remote in Delaware Job at UnitedHealth Group, Delaware, OH

  • UnitedHealth Group
  • Delaware, OH

Job Description

at UnitedHealth Group in Wilmington, Delaware, United States

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The Practice Performance Consultant RN is a remote position with traveling to physician practices. Case managers review charts (paper and electronic – EMR ), look for gaps in care, perform assessments, help coordinate doctor appointments, make follow-up calls to members after appointments, and assist our members in overall wellness and prevention. Case managers primarily work at physician practices on a daily basis.

If you are live in the Delaware regional area for travel purposes, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

+ Conduct telephonic member needs assessments according to state and national guidelines, policies, procedures, and protocols

+ Interact with patients via telephone; Schedule appointments, Follow up calls to assess understanding of services, answer questions and ascertain that additional procedures have been completed

+ Provides care coordination/case management through physician practices for members to improve clinical quality and clinical documentation. No direct patient care

+ Review member charts prior to a physician appointment and create alerts/triggers to highlight Star opportunities for the practice

+ Partner with the practice’s administrative and clinical staff while managing patient appointments and data between visits

+ Create and maintain a professional and supportive relationship with the patient, provider and office staff

+ Facilitates appropriate member referrals to special programs such as Behavioral Health, Advanced Illness and Social Services

+ Assists the member to access community, Medicare, family and other third-party resources as appropriate

+ Collaborates and communicates with the member’s health care and service with our interdisciplinary delivery team to coordinate the care needs for the member

+ Provides education to members regarding health care needs and available services

+ Works to facilitate member compliance with their care/treatment plan and to ensure continuity of care

+ Identifies barriers to optimal care and outcomes or clinical concerns and communicate with members and providers to formulate action plan to address

+ Documents all care coordination activities and interventions in the member’s health plan clinical record

+ Maintains a focus on timely, high-quality customer service

+ Maintains the confidentiality of all sensitive information

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

+ Current, unrestricted RN license in the State of Delaware

+ 3+ years of clinical experience in a hospital, acute care, home health, direct care or case management

+ Intermediate level of proficiency entering/retrieving data in electronic clinical records

+ Intermediate level of proficiency with MS Office products (i.e., Word, Excel, PowerPoint)

+ Ability to travel to provider offices within service area approximately 25% of the time as business needs dictate

+ Ability to provide proof of a valid and unrestricted driver’s license, proof of insurance and ability to travel to provider offices or other locations within service delivery area

Preferred Qualifications:

+ Bachelors of Science in Nursing

+ Case Management experience including Certification in Case Management

+ Experience with HEDIS and EMR (electronic medical records)

+ Experience with navigating and analyzing reports in Microsoft Excel

+ Medicaid, Medicare, Managed Care experience

+ Physician Office experience

+ Home care/field based case management

+ Experience in intensive care ( ICU ),emergency department (ER) nursing, or Home Health

+ Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs

+ Call Center experience

Soft Skills:

+ Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action

+ Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others

+ Demonstrated ability to identify with a consumer in order to understand and align with their needs and realities

+ Demonstrated ability to perform effective active listening skills to empathize with the customer in order to develop a trust and respect

+ Demonstrated ability to take responsibility and internally driven to accomplish goals and recognize what needs to be done in order to achieve a goal(s)

+ Demonstrated ability to turn situations around and go above and beyond to meet the needs of the customer

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes – an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.


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